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OBJECTIVES:. Critically ill patients with COVID-19 experience high rates of delirium and coma. Whether delirium occurs through novel mechanisms in COVID-19 is not known. We analyzed the relationship among biomarkers of inflammation (C-reactive protein [CRP]), hypercoagulability (d-dimer), and lung macrophage activation (ferritin), and the primary composite outcome of delirium/coma next day. We also measured associations between biomarkers and next day delirium and coma independently, and delirium severity. DESIGN:. Retrospective, observational cohort study. SETTING:. ICUs at two large, urban, academic referral hospitals. PATIENTS:. All consecutive adult patients admitted to the ICU from March 1, 2020, to June 7, 2020, with COVID-19 with clinical biomarkers and delirium assessments performed. INTERVENTIONS:. None. MEASUREMENTS AND MAIN RESULTS:. Daily concentrations of CRP, d-dimer, and ferritin were obtained. Coma (assessed by Richmond Agitation-Sedation Scale) and delirium (assessed by Confusion Assessment Method for the ICU/Confusion Assessment Method for the ICU-7) were measured bid. A cohort of 197 ICU patients with COVID-19 were included. Higher d-dimer (odds ratio [OR], 1.57; 95% CI, 1.17–2.12; p < 0.01) and ferritin quartiles (OR, 1.36; 95% CI, 1.02–1.81; p < 0.01) were associated with greater odds of the composite outcome of delirium/coma next day. d-dimer was associated with greater odds of next day delirium (OR, 1.49; 95% CI, 1.14–1.94; p < 0.01) and coma independently (OR, 1.52; 95% CI, 1.08–2.14; p = 0.017). Higher ferritin quartiles were associated with greater odds of next day delirium (OR, 1.33; 95% CI, 1.04–1.70; p = 0.026) and coma independently (OR, 1.59; 95% CI, 1.14–2.23; p < 0.01). Higher CRP quartiles were associated with coma (OR, 1.36; 95% CI, 1.03–1.79; p = 0.030) and delirium severity the next day (β = 0.30; se, 0.07; p ≤ 0.01). CONCLUSIONS:. Our hypothesis-generating study found d-dimer and ferritin were associated with delirium/coma the following day, as well as delirium and coma independently. CRP was associated with next day coma and delirium severity. Larger studies to validate these results are needed.

In this paper, we present different microelectromechanical systems based on electrostatic actuators, and demonstrate their capacity to achieve large and stepwise displacements using a cooperative function of the actuators themselves. To explore this, we introduced micro-stepper actuators to our experimental systems, both with and without a guiding spring mechanism; mechanisms with such guiding springs can be applied to comb-drive and parallel-plate actuators. Our focus was on comparing various guiding spring designs, so as to increase the actuator displacement. In addition, we present systems based on cascaded actuators; these are converted to micromechanical digital-to-analog converters (DAC). With DACs, the number of actuators (and thus the complexity of the digital control) are significantly reduced in comparison to analog stepper-actuators. We also discuss systems that can achieve even larger displacements by using droplet-based bearings placed on an array of aluminum electrodes, rather than guiding springs. By commutating the voltages within these electrode arrays, the droplets follow the activated electrodes, carrying platforms atop themselves as they do so. This process thus introduces new applications for springless large displacement stepper-actuators.

Energy poverty vulnerability constitutes a significant concern in Portugal, with 17.5% of the population being unable to keep their home adequately warm. Furthermore, there is evidence that a substantial number of children live in unhealthy homes. This study aims to comprehensively characterise a sample of 101 Portuguese families with children and their homes in order to identify opportunities for actions for promoting long-lasting energy efficiency and environment health-promoting behavioural changes. To accomplish this aim, two tools—a building survey checklist and a questionnaire to participants—were developed and implemented to collect harmonised data on building-specific characteristics and on participants’ socioeconomic status and behaviour. The home visits for recruitment and data collection were conducted from July 2021 to April 2022. The results suggest that, for the population under study, the main opportunities for improvement include: (i) replacing low energy-efficient technologies, with high emission rates, namely those used for heating purposes, with cleaner and more efficient alternatives; (ii) providing citizens with detailed information about their home’s energy use and indoor air quality and (iii) educating the population on the best-practices for reducing indoor air stuffiness, mitigating the risk of hazardous exposures, improving thermal comfort and saving energy.